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Please enter your name (required)

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Please enter your name (required)

2

Please enter your email address (required)

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Please enter your email address (required)

3

Phone number (required)

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Phone number (required) ext.

4

Address (required)

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Address (required)

5

Do you have a St. Lucie County Library card? (answer required)

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Do you have a St. Lucie County Library card? (answer required)

Yes

No

6

Reason for requesting Books by Mail service

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Reason for requesting Books by Mail service

I am convalescing from surgery or injury

I have a physical disability or chronic illness

I have transportation difficulties

I am a caregiver

7

Please enter favorite authors, genres, other reading interests, or comments and questions

Please enter favorite authors, genres, other reading interests, or comments and questions

8

Preferred formats (check all that apply)

Preferred formats (check all that apply)

Large type Books

Regular print books

Paperback books

Audiobooks on CD

DVD videos

Music CDs

9

Preferred types of books, videos or music

Preferred types of books, videos or music

Best-Sellers

Classics

Mystery

Suspense

Espionage

Science fiction/fantasy

Christian

Historical fiction

Western

Romance

Biography

Travel

Science nonfiction

Health

Self-Help

Philosophy

Genealogy

Handicrafts

Urban fiction

Humor

Florida-Related

Rock

Jazz

Pop

Country

Folk

Classical

10

I give permission to the St. Lucie County Library to keep a record of library materials sent to me in order to avoid duplication. This information will be kept confidential.

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I give permission to the St. Lucie County Library to keep a record of library materials sent to me in order to avoid duplication. This information will be kept confidential.

Yes

No

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